Roger A. Bell

Evaluating the mediating effects of social support upon life events and depressive symptoms

Previous research has yielded inconsistent results regarding the mediating effects of social support upon psychiatric illness. Using data (N = 2029) gathered as part of a major epidemiologic study in the southeastern United States, the authors examine the relationships among depressive symptoms, social support, stressful life events, and socioeconomic status. As anticipated, direct effects were found for social support, stressful life events, and socioeconomic status upon depressive symptoms. However, when the data were analyzed via three-way analysis of variance and multiple regression (including all possible interaction terms) analysis, no statistically significant interactive effects were found. The authors conclude that these findings clearly demonstrate direct effects of social support and stressful life events upon depressive symptoms. Respondents in the lower social support groups experience the greatest impact of stressful life events; in contrast, persons in high social support groups, although evidencing increased symptom scores with increasing numbers of life events, experience the buffering effect of social support by showing less severe distress.

A critique of social indicators analysis and key informants surveys as needs assessment methods

This paper reports data from a pilot study designed to determine the practicality and utility of two differing needs assessment methodologies: social indicators analysis and key informants surveys. The authors found social indicators analysis successfully identified differential areas of need within the SMSA which served as the research site. They suggest it is a practical and valid means for assessing human service needs at a general level. The key informants survey was judged to be less useful. Informants generally were unable to identify the extent of differing types of needs or their geographic distribution. It is suggested additional research utilizing differing designs must be completed before meaningful conclusions can be reached about the utility of the key informants survey as a needs assessment method.

The Clergy as a Mental Health Resource: Parts I and II

Parts I and II of this article contain some of the results of a recent research project conducted in an area of mid-Florida. The group surveyed was predominantly parish clergy. This article gives some indication of the results of this survey as it speaks to the issue of the clergy as a mental health resource. There is a good deal of serendipity data that spin off from the central theme. The article has immediate relevance for clinical pastoral education supervisors, parish clergy, and others in the field of health care delivery.

Consultative psychiatry in both private and public general hospitals.

Most psychiatric patients obtain care in the nonpsychiatric units of general hospitals. Two groups of 100 psychiatric consultation patients in a private hospital setting and in a public hospital were compared. Significant differences were found. Patients in the public hospital were medically, psychiatrically, and socioeconomically more disabled. In the private setting, psychiatric consultants were usually seen as members of a treatment team. The public facility expected consultants to function as psychiatric triage officers. However, both patient groups had a similar frequency of psychiatric illness and had an equal need for psychiatric services.

The tip of the iceberg: psychiatric consultations on an orthopedic service.

One hundred and one consecutively admitted orthopedic patients with leg fractures participated in a study assessing psychiatric morbidity using the BSI- and SMAST-questionnaires. Patients identified as probable cases of psychopathology were then psychiatrically evaluated to establish diagnoses. It was determined that about 70 percent of the sample met the criteria for psychiatric diagnoses, with substance abuse being the leading group of disorders. The psychiatric consultation-liaison and orthopedic services remained blind to the research activities and continued to refer patients for psychiatric consultation when clinically necessary. Only six (5.9%) of the patients also participating in the study were referred for clinical consultation, and these appeared to have very obvious symptoms or complaints. The large majority of emotional distress remained unnoticed.

Change and psychopathology: Epidemiologic considerations

The authors report data collected on 3674 subjects between 1970 and 1974 as part of an epidemiologic field survey of mental disorder in the southeastern United States, an area which was undergoing rapid sociocultural change. Rates of mental disorder, as measured by the Global Psychopathology Scale, are presented for various sociodemographic groups and are consistent with trends found in previous studies. Analysis of variance and multiple regression techniques are used to explore the relationships among awareness of social change, sociodemographic variables, and psychopathology. Low awareness of change is found to be consistently associated with low psychopathology scores across all socioeconomic groups. The authors postulate a “denial” or “filter” mechanism which may protect particularly vulnerable individuals from the psychic distress accompanying social change.

Psychiatric Assessment of Leg Fracture Patients: A Pilot Study

Of 200 consecutively admitted leg fracture patients, 101 consented to be screened for psychopathology using the BSI and SMAST questionnaires. Probable cases of psychopathology were referred for diagnostic psychiatric evaluation. Of the participants, 80.2 percent were identified as possible psychiatric cases. Diagnostic evaluation revealed high prevalence of substance abuse (66.0%), depression (46.8%), and personality pathology (38.3%). Accident victims tended to be single young males. Accidents occurred mostly during leisure hours, and were often associated with alcohol use. Psychiatric assistance appears essential in the management of such patients. Psychiatrists need to be especially knowledgeable about chemical dependency, interpersonal issues and psychotherapy.

Evaluation of pediatric oncology objectives developed by the American association for cancer education

Educational objectives in pediatric oncology for medical students developed at the Fall, 1981 meeting of the American Association for Cancer Education (AACE) were reviewed. These six terminal (general) and 40 enabling (specific) objectives were converted into 130 statements which were ranked from essential (rank 5) to not required (rank 0). The 58 pediatric oncology respondents gave broad support to the AACE pediatric oncology objectives. Primary importance was given to medical students knowing to refer pediatric malignancies. Principles of therapy, psychosocial management, management of infection, and complications during long term surveillance ranked high. Objectives were not ranked differently when related to number of new pediatric patients seen, type of hospital, or whether the institution had a core undergraduate pediatric training site. The list of terminal, enabling and supplemental pediatric oncology objectives developed by AACE appears valid for inclusion in the core curriculum of medical students.